Research into practice

Jill Manthorpe looks at a series of new
publications that could help to unravel the complexities of direct
payments and social services finance.

The Community Care (Direct Payments) Act 1996
gave local authorities the power to make cash payments for
community care direct to those people who need services. Direct
payments have been championed because they promote independence and
choice, and are able to bring about improvements in the quality of
life of people who would like to manage their own support.

From
April 2002, local authorities, rather than having the power to
offer direct payment schemes, now have a duty to do so. For many
this will be a challenge as well as an opportunity. Involvement
with money is complex and multi-layered in social work. A series of
new publications provide helpful pointers to unravelling some of
the issues.

Help
the Aged’s report of a seminar on direct payments and older people
sets out some of the advantages for older people in achieving
greater choice and control over their social care. It includes
examples from Manchester and Portsmouth about the practicalities
and systems that appear helpful in developing direct payment
schemes. A range of examples illustrates ways in which direct
payments can improve older people’s self image and relationships
with their families. It is also recommended that support groups,
user training, and easy-to-find and easy-to-read information should
be made available.

Meanwhile, local authorities
continue to carry out charging policies for many services. A new
research report by Fay Wright, senior fellow at the Age Concern
Institute of Gerontology, King’s College London, throws light on a
group about whom we know little – those older people who pay for
their own residential or nursing home care. Wright found that many
were excluded from needs assessments and so could miss advice about
possible alternatives to institutional care. She also observed that
self-funding residents are treated very differently between local
authorities. Some may make a contract with a home for a
self-funding resident, while others do not. The ways in which a
carer was treated if living in the older person’s home while the
option of residential care was considered also varied. Many
self-funding residents pay more for their place in a home than a
contracted social services place – in effect subsidising local
authority payments.

This
research confirms that a perverse incentive still exists in respect
of older homeowners considering residential care. They need better
information and advice. Many might benefit from professional
assessment of their needs for support. As for other older people,
developments of low-level support might be an effective
response.

Lastly, at a broader level, where
local authorities get their money from in respect of direct
payments and why they might suffer financial pressures leading to
such situations highlighted by Wright’s research, are questions
that relate to how they are themselves financed. Glasby and Glasby
have produced a guide to social services finance that looks set to
be useful in communicating ideas about the “big picture” and how
local resources relate to funding systems.

This
guide fills a major gap in practice knowledge by outlining where
social services departments’ money comes from and how this is
calculated and allocated in England. Details of standard spending
assessments (SSAs) and other systems are outlined, and such
material is placed in the context of reconciling different locally
inspired priorities and increasing central determination of funding
and priorities.

– Help
the Aged, Direct Payments, Direct Control: Enabling Older People to
Manage their Own Care, Help the Aged, 2002

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